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2 ASSOCIATED STUDENTS, INCORPORATED CALIFORNIA STATE POLYTECHNIC UNIVERSITY, POMONA EMPLOYEE ACKNOWLEDGEMENT OF RECEIPT AND REVIEW OF INJURY AND ILLNESS PREVENTION PROGRAM DOCUMENT This is to acknowledge that I have received and reviewed with my supervisor the ASI Injury and Illness Prevention Program (IIPP) document and understand that it contains important information on the organization s policies and procedures regarding employee safety. I further understand that I am governed by the contents of the IIPP and that the corporation may change, rescind or add to any policies and procedures described in the IIPP, from time to time in its sole and absolute discretion, with or without prior notice. The company will advise employees of material changes within a reasonable time. EMPLOYEE S SIGNATURE DATE EMPLOYEE S NAME (typed or printed) SUPERVISOR S SIGNATURE DATE SUPERVISOR S NAME (typed or printed) Original: Human Resources Office Copies: (1) Employee; (2) Supervisor; (3) Associate Executive Director s Office Created on September 26, 2005

3 POLICY STATEMENT It is the policy of California State Polytechnic University, Pomona Associated Students, Incorporated (ASI) that accident prevention shall be considered of primary importance in all phases of operation and administration. It is the intention of ASI's management to provide safe and healthy working conditions and to establish and enforce safe practices at all times by all employees. The prevention of accidents is an objective affecting all levels of the organization and its activities. It is, therefore, a basic requirement that each supervisor make the safety of employees an integral part of his / her regular management function. It is equally the duty of each employee to accept and follow established safety regulations and procedures. Every effort will be made to provide adequate training to employees. However, if an employee is ever in doubt about how to do a job safely, it is their duty to ask a qualified person for assistance. Employees are expected to assist management in accident prevention activities. Unsafe Conditions must be reported. Fellow employees who need help should be assisted. Everyone is responsible for the housekeeping duties that pertain to their jobs. Any injury that occurs on the job, even a slight cut or strain, must be reported to management as soon as possible. Employees shall never leave their work shift without reporting any injuries that have occurred. Created on September 26,

4 INJURY & ILLNESS PREVENTION PROGRAM Associated Students, Inc. (ASI), Cal Poly Pomona has established, implemented and is maintaining this written Injury and Illness Prevention Program (IIPP). This program has been established in accordance with Title 8, California Code of Regulations, Section 3203 of the General Industry Safety Orders and the U.S. Department of Labor, Standard 29 Code of Federal Regulations, General Industry, Part Our safety and health program includes the following elements: I. Management commitment and assignment of responsibilities II. III. IV. System for assuring employee compliance with safe work practices Safety communications system with employees Scheduled inspections and evaluation system V. Accident investigation VI. VII. VIII. Procedures for correcting unsafe and unhealthy conditions Safety and health training and instruction Recordkeeping and documentation Our commitment to safety and health begins with the complete support of Cora Culla, Executive Director. We are committed to controlling work-place hazards and correcting hazardous conditions or practices as they occur or are recognized. This commitment is backed by strong organizational policies, procedures, and disciplinary actions as necessary to ensure employee compliance with safe and healthful work practices. Created on September 26,

5 I. AUTHORITY AND RESPONSIBILITY STATEMENT ASI has a commitment to the safety and health of employees in the course of performing their work. Under the program, the Executive Director holds all Directors, Coordinators and Supervisors responsible for the safety of employees in their charge. Accountability will be demonstrated by safety audits and reviews of how the IIPP is implemented at each department. Compliance with these procedures will be part of each Director, Coordinator, Supervisor and employee's performance evaluation. We recognize that the responsibility for safety and health is shared. ASI has assigned authority and responsibility as follows: 1. Safety Officer Powell Velasco, Associate Executive Director is responsible for ASI s Safety Program. In accordance with ASI s Injury and Illness Prevention Program, he has the responsibility and authority to do the following in the name of ASI: a. Develop and implement rules of safe practices within the company. b. Develop and implement a system to encourage employees to report unsafe conditions immediately. c. Document all accident and illness investigations to determine cause and prevent recurrence. d. Instruct Directors, Coordinators and supervisors in safety responsibilities. e. Develop and implement a program of employee safety education. f. Conduct scheduled and unscheduled inspections to identify and correct unsafe working conditions. g. Maintain records of training, periodic inspections, corrective actions and investigations. h. Ensure that appropriate planning and funding are provided to support the needs of the safety program. Created on September 26,

6 2. Directors, Coordinators and Supervisors In accordance with ASI s Injury and Illness Prevention Program, Directors, Coordinators and supervisors have the responsibility to do the following: a. Know and enforce all safety and health rules, regulations, and procedures. b. Ensure that all employees are properly trained in workplace safety and health. c. Investigate and prepare accident and illness reports within 24 hours of occurrence. d. Follow up on recommendations resulting from accident or illness investigations or inspection reports. e. Remain alert to unsafe conditions and practices and take appropriate steps to eliminate them. f. Provide feedback to both the Safety Officer and employees on any safety concerns. g. Monitor preventative maintenance in area and conduct regular inspections. h. Repair or replace all equipment that is not in good working order. i. Make time available for safety issues on regular meeting agendas. j. Display all appropriate safety bulletins, forms, and building diagrams in an area that is readily accessible to all employees. 3. Employees Occupational safety and health is ultimately a matter of each individual making a deliberate conscious effort to perform his or her job duties in a safe manner. Safety is indeed a "State of Mind." There is no safety and health program, no coordinator, and no written standard operating procedure that can make an employee safe" unless the employee chooses to work safely. Consequently, the ultimate responsibility and ultimate authority for any individual's safety and health lie with that individual, and his or her colleagues. Each employee is responsible for exercising the utmost care and good judgment in protecting his or her own safety and health and that of fellow employees. Should any employee observe a potentially unsafe condition or situation, it is the responsibility of that employee to immediately bring the observed condition to the attention of the appropriate safety and health personnel as designated in this Manual. Created on September 26,

7 Employees are responsible for following all written and verbal safety policies and procedures, and shall: a. Report all work-related injuries immediately to their supervisor, no matter how minor. b. Perform duties using safe work practices. c. Report unsafe conditions, work practices or hazards to their supervisor. d. Report equipment failures immediately to their supervisor. e. Knowing, observing and enforcing safety policies and procedures. f. Perform only authorized jobs. g. Actively contribute to the success of the overall safety program by providing ideas and suggestions to help prevent accidents and injuries. NOTE: An employee has the right and duty to refuse to perform a task with more than a reasonable level of risk until appropriate risk control measures have been instituted. 4. Safety Committees: The Safety Committee is a joint worker-management team that assists the employer in creating and maintaining a safe workplace. The goal of the committee is to enhance the ability of workers and employer to resolve health and safety concerns reasonably and co-operatively. The Safety Committee s role includes the following duties: a. Review internal policies and procedures related to safety. b. Review of reported work-related injuries and illnesses and make recommendations as appropriate. c. Oversee that Health and Safety Inspections are being done on a quarterly basis, by each department. d. Monitor operational changes or new construction to ensure that safety regulations are met. e. Review Employee Report of Unsafe Workplace Condition or Practice reports and ensure that corrective action plans are developed and implemented. Created on September 26,

8 f. Develop and implement safety awareness and incentive programs that will encourage employees to work safely. II. COMPLIANCE The designated Safety Officer for ASI is responsible for ensuring that all health and safety policies and procedures are clearly communicated and understood by all employees. The Safety Officer is expected to enforce the rules fairly and uniformly. All employees are responsible for using safe work practices, following all directives, policies and procedures, and for assisting in maintaining a safe work environment. ASI s system of ensuring that all workers comply with these practices includes but is not limited to the following: a. Informing employees of the provisions of the Injury and Illness Prevention Program in a "readily understandable" language. b. Evaluating the safety performance of all employees as part of each employee's performance evaluation. c. Recognizing employees who perform safe and healthful work practices. d. Providing additional training to employees whose safety performance is deficient. e. Disciplining employees for failure to comply with safe and healthful work practices. III. COMMUNICATION ASI recognizes that open, two-way communication between management and staff on health and safety issues is essential for an injury-free, productive workplace. ASI will use the following systems of communication designed to facilitate a continuous flow of safety and health information between management and staff in a form that is readily understandable: 1. Department Safety Meetings a. The Safety Officer will ensure that department safety meetings are held on Created on September 26,

9 a regular basis. During these meetings safety will be freely and openly discussed with the employees on such issues as: New hazards that have been introduced or discovered in the workplace. Causes of recent accidents or injuries and the methods adopted to prevent similar incidents in the future. Any health or safety issue deemed necessary by the Safety Officer to require reinforcement. Annual retraining on required procedures. b. Documentation in the form of meeting agendas and minutes of all Safety Meetings and a list of employees in attendance will be kept for 3 years. 2. Notification Procedures It is the responsibility of each employee to immediately inform their supervisor or the Safety Officer of any hazard or unsafe condition in the work site. Employees are also encouraged to direct any questions or concerns they have regarding safety issues or the IIPP to their supervisor or the Safety Officer and understand that this will occur without fear of reprisal in any form. Employees can also notify the Safety Officer of any such hazards anonymously if they prefer to do so. Suggestions can be placed in the Associate Executive Director s mail box located in the ASI Administration office, Room Postings A safety bulletin board will be used and located in each department to post safety-related information, accessible to all employees. The safety bulletin board will at a minimum consist of: Emergency Phone Numbers Designated safe areas for emergency evacuations Department safety meeting minutes Employee Report of Unsafe Workplace Condition or Practice forms Department Health and Safety Inspection Report IV. HAZARD ASSESSMENT AND IDENTIFICATION Created on September 26,

10 Periodic inspections provide a method of identifying existing or potential workplace hazards, and eliminating or controlling them. 1. Each department will have regularly scheduled and documented safety inspections to help prevent hazards from occurring. These inspections will be performed using the Department Health and Safety Inspection Report. 2. In addition, each department will conduct an unscheduled and documented safety inspection and or investigation when new substances, processes, procedures or equipment that present potential new hazards are introduced into the workplace. These inspections will be performed using the Hazard Assessment Form. 3. Employees are encouraged to report possible hazardous situations, knowing their reports will be given prompt and serious attention without fear of reprisal. 4. Whenever possible, it is the intent of ASI to abate immediately any hazard which gives rise to a risk of imminent harm. V. ACCIDENT AND EXPOSURE INVESTIGATIONS All accidents and injuries must be reported immediately to the supervisor. Procedures for investigating workplace accidents and hazardous substance exposure should be performed in a timely manner by the Safety Officer and/or the employee's supervisor. Supervisors should be aware that accident investigation is an important function and good preparation is necessary. This includes a careful review of witness statements. Let the employee "think through" the accident and "do the talking". Ask the employee to explain how it could have been prevented. Supervisors should take the following steps when performing an accident investigation: 1. Visit the accident scene as soon as possible. 2. Interview injured employees and witnesses. 3. Examine the workplace for factors associated with the accident and or exposure. 4. Determine the cause of the accident and or exposure. 5. Take corrective action to prevent the accident and or exposure from recurring. Created on September 26,

11 6. Record the findings and corrective actions taken on the Report of Employee Injury or Illness form and send to the Human Resources Office with a copy to the Safety Officer. The investigation should produce answers to the six Ws of accident investigation as follows: 1. What happened? 2. When did it happen? 3. Where did it happen? 4. Who was affected? 5. Why did it happen? 6. What can be done to prevent a similar accident? The six "Ws" is vital to the success of the investigation. Supervisors are expected to provide adequate, meaningful accident reports. Thorough investigation of all accidents and near misses will help us identify causes and needed corrections, and can help us determine why accidents occur, where they happen, and any accident trends. Such information is critical to preventing and controlling hazards and potential accidents. All "reportable" injuries or illnesses must be recorded within six (6) workdays after learning of the occurrence, on the OSHA 300 log. VI. Hazard Correction Unsafe or unhealthy work conditions, practices or procedures shall be corrected in a timely manner based on the severity of the hazards. Hazards shall be corrected according to the following procedures: 1. When observed or discovered. ASI will let the employees know that a hazardous situation was corrected (or wasn't hazardous), thereby creating a system by which employees continue to report hazards promptly and effectively. 2. When an imminent hazard exists which cannot be immediately abated without endangering employee(s) and or property, ASI will remove all exposed employees from the area except those necessary to correct the existing condition. Employees necessary to correct the hazardous condition shall be provided with the necessary personal protective equipment. 3. All such actions taken and dates they are completed shall be documented. Created on September 26,

12 VII. SAFETY & HEALTH TRAINING Training is required for both supervisors and employees alike. Supervisors will provide training to each employee about general safety and health procedures and any hazards or safety and health procedures specific to the employee s work assignment. ASI will also provide training to each supervisor on recognized hazards, how to identify new hazards, the potential effects of these hazards, and how to minimize these hazards and maintain a safe workplace. Training will be provided as follows: Upon hire Whenever an employee transfers to a new assignment for which training has not previously been provided Whenever new substances, processes, procedures or equipment which represent a new hazard are introduced into the workplace Whenever the employee is made aware of a new or previously unrecognized hazard Whenever the supervisor, employee or Safety Officer believes additional training is necessary All safety and health training is to be documented using the Employee Training Record form. Documentation will include the employee s name, training date, type of training, and the person, company or organization providing the training. The supervisor will maintain all such training documentation for a period of three years. General workplace safety and health practices for ASI include but are not limited to: 1. Implementation and maintenance of the IIPP. 2. Emergency preparedness and fire safety plan. 3. Provisions for medical services and first aid including emergency procedures. 4. Prevention of musculoskeletal disorders, including proper lifting techniques. Created on September 26,

13 5. Proper housekeeping, such as keeping stairways and aisles clear, work areas neat and orderly, and promptly cleaning up spills. 6. Prohibiting horseplay, scuffling, or other acts that may adversely influence safety. 7. Proper storage to prevent stacking goods in an unstable manner and storing goods against doors, exits, fire extinguishing equipment and electrical panels. 8. Proper reporting of hazards and accidents to supervisors. 9. Hazard communication, including worker awareness of potential chemical hazards, and proper labeling of containers. 10. Proper storage and handling of toxic and hazardous substances including prohibiting eating or storing food and beverages in areas where they can become contaminated. VIII. RECORDKEEPING & DOCUMENTATION The Safety Officer with assistance from Directors, Coordinators, Supervisors and the Human Resources Office documents the implementation and maintenance of ASI s IIPP in the following manner: 1. Records of hazard assessment inspections, including the person(s) conducting the inspection, the unsafe conditions and work practices that have been identified and the action taken to correct the identified unsafe conditions and work practices, are recorded on a Hazard Assessment Form. 2. Documentation of safety and health training for each worker, including the worker's name or other identifier, training dates, type(s) of training, and training providers are recorded on an Employee Training Record form. 3. Maintaining a log of all recordable occupational injuries and illnesses as required by the Occupational and Safety and Health Act of The form used Log and Summary of Occupational Injuries and Illness (OSHA No. 300) is required by Public Law and is supplied by OSHA. Inspection records and training documentation will be maintained for one year, except for training records of employees who have worked for less than one year which are provided to the employee upon termination of employment. OSHA 300 logs must be maintained and retained for 5 years following the end of the calendar year to which they relate. They must be available for inspection and copying by representatives of the Department of Labor, or the Department of Created on September 26,

14 Health and Human Services. Also, employees, former employees and or their representatives must be allowed access to the log. The Human Resource Office is responsible for maintaining the OSHA 300 log and posting it each year from February 1 through April 30. Created on September 26,

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